A nurse is caring for a client who is dying of metastatic breast cancer. She has a prescription for an opioid pain medication PRN. The nurse is concerned that administering a dose of pain medication might hasten the client's death. Which of the following ethical principles should the nurse use to support the decision not to administer the medication?

A. While heparin and warfarin both work as anticoagulants, IV heparin is not typically used to increase the effects of warfarin or decrease the length of hospital stay. Heparin is often administered initially to rapidly achieve therapeutic anticoagulation while waiting for warfarin to reach its full therapeutic effect, but it is not intended to directly enhance the action of warfarin.
B. This statement is accurate and provides a clear explanation to the client. Warfarin, an oral anticoagulant, takes several days to achieve a therapeutic level in the bloodstream and to exert its anticoagulant effect. During this time, IV heparin is continued to prevent clot formation until the therapeutic level of warfarin is reached.
C. While both heparin and warfarin work to prevent blood clots, they do not directly dissolve existing clots. Rather, they prevent the formation of new clots and the growth of existing ones. This explanation does not fully address the client's question regarding why both medications are necessary.
D. Discontinuing IV heparin prematurely without reaching a therapeutic level of warfarin could increase the risk of thrombus formation or embolization. Therefore, discontinuing IV heparin should be done under the guidance of the provider based on the client's INR levels and the target therapeutic range for warfarin.

A. Instruct the client to sit down and stop pacing: Instructing the client to sit down and stop pacing may escalate the client's anxiety and agitation. It's important to provide support and assistance rather than giving orders that could exacerbate the situation.
B. Have a staff member escort the client to her room: Forcing the client to go to her room may increase feelings of being trapped or controlled, potentially worsening the anxiety. It's important to respect the client's autonomy and provide support in a less restrictive manner.
C. Allow the client to pace alone until physically tired: While it's important to allow clients some degree of autonomy, pacing alone may not effectively address the client's escalating anxiety. The nurse should remain engaged and offer support during this time.
D. Walk with the client at a gradually slower pace: This is the most appropriate action. Walking alongside the client allows the nurse to provide support, demonstrate empathy, and potentially de-escalate the situation. Gradually slowing the pace can help the client regulate their own emotions and decrease anxiety. It also provides an opportunity for therapeutic communication and assessment of the client's needs.